Annals of family medicine
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Annals of family medicine · Jul 2013
Physician communication regarding prostate cancer screening: analysis of unannounced standardized patient visits.
Prostate cancer screening with prostate-specific antigen (PSA) is a controversial issue. The present study aimed to explore physician behaviors during an unannounced standardized patient encounter that was part of a randomized controlled trial to educate physicians using a prostate cancer screening, interactive, Web-based module. ⋯ A brief Web-based interactive educational intervention can improve shared decision making, neutrality in recommendation, and reduce PSA test ordering. Engaging patients in discussion of the uses and limitations of tests with uncertain value can decrease utilization of the tests.
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Annals of family medicine · Jul 2013
Care from family physicians reported by pregnant women in the United States.
We describe the proportion of family physicians providing care of any sort to pregnant women in the United States from 2000 to 2009. ⋯ Trends in family medicine care for pregnant women have remained steady for the nation as a whole, but they differ by region of the United States. Most pregnant women reported care from multiple clinicians, highlighting the importance of care coordination for this patient population.
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Annals of family medicine · Jul 2013
Impact of individual and team features of patient safety climate: a survey in family practices.
Knowledge about safety climate is fundamental to improving patient safety in health care organizations. Because individual and organizational factors influence the safety climate, we conducted a health care survey of German family practices so we could analyze the impact of the professional group, the professional experience of practice staff, and practice characteristics on perceptions of the safety climate. ⋯ Though the safety climate in German family practices was positive overall, health care professionals' use of incident reporting and a system's approach to errors was fairly rare. When evaluating the safety climate in primary health care practices, respondents' individual characteristics, as well as organizational features, should be taken into account.
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Annals of family medicine · Jul 2013
Preventive services delivery in patients with chronic illnesses: parallel opportunities rather than competing obligations.
Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database derived from electronic health records. ⋯ Rather than a barrier, the presence of chronic illness was positively associated with receipt of recommended preventive services in this large national PBRN. This finding supports the notion that modern primary care practice can effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.
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Our careers began with the long, arduous, and intensely focused commitments of premed, medical school, residency, and fellowship. We planned our lives rationally and enacted our plans with care. Now we have long-desired and satisfying careers. We discovered something, however, that the culture of medical training and our plans had failed to anticipate: We did not allow time for the unexpected.